Rationale: Single-site clinic-based studies suggest an increasing prevalence of pulmonary nontuberculous mycobacteria (NTM) disease, but systematic data are lacking. Objectives: To describe prevalence and trends for NTM lung disease at four geographically diverse integrated heath care delivery systems in the United States. Methods: We abstracted mycobacterial culture results from electronic laboratory databases and linked to other datasets containing clinical and demographic information. Possible cases were defined as a single positive NTM pulmonary isolate, and definite cases were defined as two positive sputum cultures, or one positive culture from a bronchoalveolar lavage or lung biopsy. Annual prevalence was calculated using United States census data; average annual prevalence is presented for 2004-2006. Poisson regression models were used to estimate the annual percent change in prevalence. Measurements and Main Results: A total of 28,697 samples from 7,940 patients were included in the analysis. Of these, 3,988 (50%) were defined as possible cases, and 1,865 (47%) of these were defined as definite cases. Average annual (2004-2006) site-specific prevalence ranged from 1.4 to 6.6 per 100,000. Prevalence was 1.l- to 1.6-fold higher among women relative to men across sites. The prevalence of NTM lung disease was increasing significantly at the two sites where trends were studied, by 2.6% per year among women and 2.9% per year among men. Among persons aged greater than or equal to 60 years, annual prevalence increased from 19.6 per 100,000 during 1994-1996 to 26.7 per 100,000 during 2004-2006. Conclusions: The epidemiology of nontuberculous mycobacterial lung disease is changing, with a predominance of women and increasing prevalence at the sites studied.

Background: Automated home monitoring systems have been used to coordinate care to improve patient outcomes and reduce rehospitalizations, but with little formal study of efficacy. The Geisinger Monitoring Program (GMP) interactive voice response protocol is a post-hospital discharge telemonitoring system used as an adjunct to existing case management in a primary care Medicare population to reduce emergency department visits and hospital readmissions. Objectives: To determine if use of GMP reduced 30-day hospital readmission rates among case-managed patients. Research Design: A pre-post parallel quasi-experimental study. Methods: A total of 875 Medicare patients who were enrolled in the combined case-management and GMP program were compared with 2420 matched control patients who were only case managed. Claims data were used to document an acute care admission followed by a readmission within 30 days in the preintervention and postintervention periods (ie, before and during 2009). Regression modeling was used to estimate the within-patient effect of the intervention on readmission rates. Results: The use of GMP with case management was associated with a 44% reduction in 30-day readmissions in the study cohort (95% confidence interval, 23%-60%, P=0.0004), when using the control group to control for secular trends. Similar estimates were obtained when using different propensity score adjustment methods or different approaches to handling dropout observations. Conclusions: Investing in automated monitoring systems may reduce hospital readmission rates among primary care case-managed patients. Evidence from this quasi-experimental study demonstrates that the combination of telemonitoring and case management, as compared with case management alone, may significantly reduce readmissions in a Medicare Advantage population.

When it comes to childhood obesity, we tend to focus a lot on processed food and lack of physical activity. But those aren't the only factors contributing to the epidemic, which affects close to 1 in 5 American kids.
A study published Tuesday shows how the trillions of bacteria that already live in children's guts also impact their risk of obesity. And this understanding may pave the way to new, and better, treatments for obesity.
By studying the gut flora of 84 children and teens—from normal weight to severely obese—researchers were able to determine that the composition of microbes in the gut flora of obese children and adolescents share a lot of similarities. Eight distinct group of microbes were associated with higher body weight, and these groups were less often found in the gut flora of leaner kids, according to the study published in the Journal of Clinical Endocrinology & Metabolism.
These differences in microbiome populations—the term for the unique blend of bacteria that live in and on every human body—mean that obese kids and teens more often have bacteria that are better at fermenting carbohydrates in the stomach, which produces higher levels of short-chain fatty acids (the term for a number of acids produced in the colon when food breaks down).
"Once short-chain fatty acids are produced, either they get expelled through feces, or most of them get absorbed," said Dr. Nicola Santoro, a Yale endocrinology research scientist and co-author of the paper.
Santoro said the researchers believe the short chain fatty acids are being absorbed in the liver and converted to fat, which would explain part of the reason why obese kids might be predisposed to put on weight.
Read More: Scientists Are Now Trying Fecal Transplants on Kids
These findings are similar to those of studies looking at the gut flora of obese adults. It's part of a slow piecing together of a puzzle that explains what role the microbiome plays in our body fat composition, and how we might be able to influence changes.
"Studies have consistently reported an association between antibiotics and gut flora and we know the microbiome plays a role in the development of metabolism and immunity," Annemarie Hirsch, a researcher at the Geisinger Center for Health Research who has authored studies on the impact of antibiotics on the development of the microbiome. "It's the connection between antibiotics to microbiome to obesity that's somewhat still a black box."
Though the microbiome in adults is more or less static—antibiotics can knock out a lot of the microbes, they will repopulate—Hirsch's research has shown that the gut flora of babies is still developing, and the overuse of antibiotics at an early age can change the composition. That overuse is also associated with a higher risk of obesity and food allergies.
Both Hirsch and Santoro said there's still a lot of work to be done and there are a lot of factors that impact risk of obesity: most obviously, diet and amount of physical exercise. But as we learn more about the role the gut flora plays, we might be able to design more strategic treatments for kids and adults who are already obese—or prevent it for those who aren't. These could include things like probiotics, or even fecal transplants, where the fecal matter of a healthy person is introduced into the bowel of another person to repopulate the gut flora with different microbes.
"That's the million dollar question," Santoro said. "If you look at animal studies, fecal transplants work perfectly in mice [for treating obesity.] The issue is: can we do this in humans? Does it work? For obesity, we don't know yet."
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